腹膜透析充分性的国际指南解读

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1、腹膜透析充分性的国际指南Shijunbao腹膜透析充分性的国际指南ISPDGUIDELINEONTARGETSFORSOLUTEANDFLUIDREMOVALINADULTPATIENTSONCHRONICPERITONEALDIALYSISKDOQICLINICALPRACTICEGUIDELINESANDCLINICALPRACTICERECOMMENDATIONS2006UPDATESERA-EDTAEUROPEANBESTPRACTICEGUIDELINESFORPERITONEALDIALYSISGUIDELINEONTARGETSFO

2、RSOLUTEANDFLUIDREMOVALINADULTPATIENTSONCHRONICPERITONEALDIALYSISISPDGUIDELINES/RECOMMENDATIONSRECOMMENDATIONS1Adequacyofdialysisshouldbeinterpretedclinicallyratherthanbytargetingonlysoluteandfluidremoval.ClinicalAssessmentClinicalandlaboratoryresultsPeritonealandrenalclearanc

3、esHydrationstatusAppetiteandnutritionalstatusEnergylevelHemoglobinconcentrationResponsivenesstoerythropoietintherapyElectrolytesandacid–basebalanceCalciumphosphatehomeostasisBloodpressurecontrolRECOMMENDATIONS2Inordertoemphasizethatthereismoretoadequatedialysisthanafocusonsma

4、llsolutekineticsandultrafiltrationtargets,theCommitteedecidedtonamethisguidelineGuidelineonTargetsforSoluteandFluidRemovalinAdultPatientsonChronicPeritonealDialysisinsteadofGuidelineonAdequacyofPeritonealDialysis.RECOMMENDATIONS3Forsmallsoluteremoval,thetotal(renal+peritoneal

5、)Kt/Vureashouldnotbelessthan1.7atanytime(EvidencelevelA).Thatmeans,inanuricpatients,peritonealKt/Vureahastobeabove1.7.RECOMMENDATIONS3Inthepresenceofresidualrenalfunction,thecontributionsofrenalandperitonealclearancesmaybeaddedforpracticalpurposes,although,asmentionedprevious

6、ly,renalandperitonealclearancesmaynotbetrulyadditive(Opinion).Soluteremovalabovethislevelshouldnotbeequatedwith“adequatedialysis.”RECOMMENDATIONS3Knowledgeofthetransportcharacteristicsofthepatient’speritonealmembranebyperitonealequilibrationtestorothertestsmayhelptooptimizeth

7、eprescriptiontomeetthistarget.RECOMMENDATIONS4AseparatetargetforcreatinineclearanceisnotrequiredinCAPD.InAPD,duetoamorevariablerelationshipbetweenureaandcreatinineclearanceanadditionaltargetof45L/week/1.73m2forcreatinineclearanceisrecommended(EvidencelevelC).RECOMMENDATIONS5F

8、orpatientswhorelysignificantlyonresidualrenalfunctiontoachievethemin